Healthcare Provider Details

I. General information

NPI: 1427248178
Provider Name (Legal Business Name): STACY NICOLE KILE MS, MA, CCCSLP, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 DEER TRACKS TRL STE 260
SAINT LOUIS MO
63131-1855
US

IV. Provider business mailing address

35 JACKS CABIN DR
DEFIANCE MO
63341-1329
US

V. Phone/Fax

Practice location:
  • Phone: 314-616-9609
  • Fax:
Mailing address:
  • Phone: 314-616-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ4252
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: